Cholera, sometimes known as Asian or epidemic cholera, is an infectious gastroenteritis caused by enterotoxin-producing strains of the bacterium Vibrio cholerae. The NIAID has characterized V. cholerae as a category 'B'-pathogen that poses a potential bioterrorism threat. Cholera is a waterborne disease and is associated with food consumption. For example, in the Americas, consumption of raw shellfish and raw vegetables has been associated with cholera outbreaks. In its most severe forms, cholera is one of the most rapidly fatal illnesses known, and a healthy person's blood pressure may drop to hypotensive levels within an hour of the onset of symptoms;infected patients may die within three hours if medical treatment or rehydration is not provided. In a common scenario, the disease progresses from the first liquid stool to shock in 4 to 12 hours, with death following in 18 hours to several days unless oral rehydration is provided. Massive liquid loss occurs after the cholera toxin (CT) first attaches to the gut epithelia via its B subunit (CTB), and then upon cell entry of its A subunit affects the electrolyte balance by activation of adenyl cyclase. There is no currently approved vaccine treatment for cholera available in the U.S. since strategies thus far have generally provided only variable, short-term immunity. Therefore, public health measures that prevent cholera, such as adequate sewage treatment and a reliable source of safe drinking water, are considered the most effective way of combating the disease. In this R21 proposal, we will develop and test in a suckling mouse model a biotechnology scaffold for protection against cholera infection. We will prepare Lactobacilli expressing an anti-CTB human single chain antibody fragment (scFv) as a bioadsorbent to remove CT from the gut. Our strategy is aimed at the clinical application of this Lactobacilli bioadsorbent, administered for example in yogurt, to either replace vaccination or for use as an adjunct passive immune therapy. We anticipate both its prophylactic utility and its use after initial exposure to the bacteria for the general public or, given the bioterrorism threat, Armed Forces Personnel and First responders. We will generate and test this new biotechnology scaffold under the remit of the following three specific aims: Specific aim #1: Selection of anti-CTB single chain antibody fragments from a human phage display library. Specific aim #2: Construction of Lactobacilli strains expressing a CTB-specific scFv antibody fragment. Specific aim #3: Studying the protective effect of gut colonization with a Lactobacilli strain expressing a CTB- specific scFv antibody against V. cholerae infection in mice. PUBLIC HEALTH RELEVANCE: In the United States, cholera was prevalent in the 1800s but has been virtually eliminated by modern sewage and water treatment systems. However, as a result of improved transportation, more persons from the United States travel to parts of Africa, Asia, or Latin America where epidemic cholera is occurring. U.S. travelers to areas with epidemic cholera may be exposed to the cholera bacterium. In addition, travelers may bring contaminated seafood back to the United States;foodborne outbreaks have been caused by contaminated seafood brought into this country by travelers. Cholera is such a problem in parts of the world that travelers from the US can receive a vaccine prior to travel. In this proposal we will develop an entirely new approach protect against cholera toxicity. We will develop a human antibody to cholera toxin and express it on Lactobacilli and colonize the gut with this biotechnology tool. It will be an invaluable tool for the traveler and first responders and armed forces personnel.